The absence of thrombogenic milieu and of left atrial stunning after CV in patients with recent-onset AF favours early CV without anticoagulation, at least in patients with a low thromboembolic risk profile. These patients could be discharged earlier from urgent care.
COVID 19 has so far found the only barrier in the use of mRNA and viral vector vaccines. Among the rare adverse effects related to mRNA vaccines is myocarditis (4.8 cases per million doses) a disease already found in COVID 19 infection but not in the safety studies of the vaccines. Males not older than 30 years (40% of the total), subjected to the second dose inoculation, are most affected. During our recent clinical practice there was a case of a patient with myocarditis, attributable to vaccination for COVID 19. It was a male, twenty–year–old, non–allergic smoker, subjected to second dose of Pfizer–BioNTech vaccine (BNT162b2). On the fifth day after the inoculation, the patient, already asthenic from the previous days, complained of an episode of oppressive chest pain, which lasted about 15 minutes, which returned, more intense the following night, associated with dyspnea, lasted for hours. When the patient went to the emergency room the pain was in regression and there was good hemodynamic compensation. EKG: sinus rhythm, slight diffuse ST segment elevation, more pronounced in the inferior–lateral leads, slight lowering of the P–R segment. Blood tests: troponin, CKMB and PCR increase, negativity of the molecular test for COVID 19. Echocardiography: normal left ventricle, non–dilated right sections, normokinetic right ventricle, normal valves, pericardial hyper–refraction without effusion, normal diastolic relaxation. In the suspicion of myocarditis, the patient was admitted to our intensive cardiological care. With the high–dose anti–inflammatory and beta–blocker therapy the pain gradually disappeared; never fever; EKG showed progressive ST segment improvement and T wave negativization. Never arrhythmic events. Negativity for all infections with common viral pathogens. MRI: hyperintensity (T2 STIR sequences and late enhancement) in the infero–lateral area. Patient discharged in therapy with lysine acetylsalicylate, to be reduced, associated with pantoprazole, and metoprolol and indicated for outpatient checks. In conclusion, the case presented reflects the scientific literature in the type of patient and in the favorable evolution of the disease.
Between summer 2020 and the end of 2021 the Cardiology facility of the Savigliano hospital trained 2 doctors and 2 nurses in hypnotic communication (IC). IC is a communicative approach, which involves establishing a relationship with the patient and can allow carrying out the planned procedure by bringing the patient into a modified state of consciousness that reverberates on physical and sensory perceptions up to a trans hypnotic. This particular connection with the patient can be represented by a simple communication deepening up to the real trance and allows to overcome the procedures with a reduction in the use of anesthetics and analgesics, with a control of procedural anxiety, up to complete analgesia, but also the management of some particular procedural needs such as the prolonged maintenance of the supine position on an operating room table with the patient awake. All patient has an extremely positive experience. Hypnosis can also optimize the abilities and performances of those who use it. During this period, at the Cardiology facility of the Savigliano we started using IC to perform procedures in the hemodynamics, electrophysiology and transesophageal echocardiography. In the hemodynamics and electrophysiology room, IC has increasingly become the preferred communicative approach to the patient who are going to have a procedure. A total of 123 patients booked for coronary angioplasty were managed in IC, including 5 in emergency, 24 PM implants and defibrillators, 3 electrophysiological studies and a foramen ovale closure procedure. In recent months, an outpatient operator has started performing IC on 10 transesophageal echocardiogram exams. In 70 patients the session was concluded with an anchorage, which is a moment in which the patient is allowed to reproduce the modified state of consciousness independently, to face moments of anxiety, fatigue or other procedures. In the majority of patients, the ratification of the presence of a trance state was positive, in a smaller percentage of cases (about 15%) the ratification was sometimes not evident or if it was, the patient was expelled during the procedure, but in 100% of cases the patient‘s experience was extremely positive both in terms of perceived closeness of the healthcare staff, and in terms of tolerance to the procedure and positive experience of the latter.
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